Smoking Complaint Reporting Form

Please use this form to report establishments not in compliance with the Washington Clean Indoor Air Act (RCW 70.160).  Fields with an asterisk (*) are required.

* Are you reporting a food establishment?
YES or NO:  

* First Name:


* Last Name:


* Your contact telephone number with area code or email address:


* Name of business you are reporting:
(please do not use nicknames or abbreviations)


* Address of business you are reporting:


* City or Town:


* Zip Code:

Reporting the problem
(Select at least one)

  Smoking allowed in a public place
  "No Smoking" signs are not posted
   Smoking allowed within 25 feet

*Date and Time of occurrence:


Additional information:
(maximum characters: 250, includes spaces)


Disclosure Information:
This complaint submittal is subject to public disclosure according to the public records act (RCW 42.56). This means anyone can request the release of the documents containing your name and contact information. However, information revealing the identity of persons who are witnesses to crimes or who file complaints with investigative agencies can be withheld from disclosure pursuant to RCW 42.56.240. If it is believed the disclosure would endanger your life, physical safety or property.

Yes, it is okay to disclose name and contact information

OR

No, do not disclose my name or contact information because I believe disclosure will endanger my life, physical safety or property.

Complaints are processed in the order received. If additional information is required, we will contact you soon.  Otherwise, you will receive a letter acknowledging receipt of your complaint.